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Ductal carcinoma in situ of the breast
Jennifer L. Peterson,Laura A. Vallow,Stephanie L. Hines,Steven J. Buskirk
Oncology Reviews , 2011, DOI: 10.4081/99
Abstract: Ductal carcinoma in situ (DCIS) of the breast is a noninvasive form of breast cancer that has increased in incidence over the past several decades secondary to screening mammography. DCIS now represents 20–30% of all newly diagnosed cases of breast cancer. Patients with DCIS typically present with an abnormal mammogram, and diagnosis is most commonly obtained with an imageguided biopsy. Historically, mastectomy was considered the primary curative option for patients with DCIS. However, treatment of DCIS continues to evolve, and now treatment strategies also include breast-conserving therapy, which consists of local excision followed by radiation therapy or local excision alone. Multiple randomized trials have confirmed a decrease in ipsilateral breast tumor recurrence in patients treated with local excision followed by radiation therapy compared with local excision alone. Ongoing clinical trials attempt to identify a subgroup of DCIS patients at low risk for recurrence who may not benefit from radiation therapy. In addition, because the majority of ipsilateral breast tumor recurrences occur near the original primary tumor site, partial breast irradiation is currently under investigation as a treatment option for DCIS patients. Randomized trials have shown tamoxifen can reduce the risk of ipsilateral and contralateral breast tumor recurrences while the role of aromatase inhibitors is the subject of current clinical trials. DCIS represents a complex pathologic entity, and treatment optimization requires a multidisciplinary approach.
Ductal Carcinoma In Situ of the Breast  [PDF]
Richard J. Lee,Laura A. Vallow,Sarah A. McLaughlin,Katherine S. Tzou,Stephanie L. Hines,Jennifer L. Peterson
International Journal of Surgical Oncology , 2012, DOI: 10.1155/2012/123549
Abstract: Ductal carcinoma in situ (DCIS) of the breast represents a complex, heterogeneous pathologic condition in which malignant epithelial cells are confined within the ducts of the breast without evidence of invasion. The increased use of screening mammography has led to a significant shift in the diagnosis of DCIS, accounting for approximately 27% of all newly diagnosed cases of breast cancer in 2011, with an overall increase in incidence. As the incidence of DCIS increases, the treatment options continue to evolve. Consistent pathologic evaluation is crucial in optimizing treatment recommendations. Surgical treatment options include breast-conserving surgery (BCS) and mastectomy. Postoperative radiation therapy in combination with breast-conserving surgery is considered the standard of care with demonstrated decrease in local recurrence with the addition of radiation therapy. The role of endocrine therapy is currently being evaluated. The optimization of diagnostic imaging, treatment with regard to pathological risk assessment, and the role of partial breast irradiation continue to evolve. 1. Introduction Ductal carcinoma in situ (DCIS) of the breast is a complex pathologic entity in which malignant cells arise and proliferate within the breast ducts without invasion of the basement membrane. The increased use of screening mammography has led to a significant increase in the diagnosis of earlier stage breast cancers, including ductal carcinoma in situ. According to the Surveillance Epidemiology and End Results program (SEER) from 1975–2008, in situ breast cancers represented approximately 15% of all new breast cancer diagnoses in the United States [1]. DCIS consists of approximately 84% of all in situ disease, with lobular carcinoma in situ (LCIS) forming the bulk of the remainder. DCIS will account for approximately 27% of all newly diagnosed breast cancers or 77,795 new cases estimated in 2011 [2]. The age-adjusted DCIS incidence had increased an average of 3.9% annually from 1973 to 1983 and approximately 15% annually from 1983 to 2008 [3]. Since 2003, the incidence of DCIS has declined in women aged 50 years and older, while the incidence continues to increase in women younger than age 50 [4]. Overall, the rate of increase in incidence has been higher for DCIS than for any other type of breast cancer. As the incidence of DCIS increases, the treatment options continue to evolve. In the past, DCIS was an uncommon disease that was routinely treated with mastectomy. However, with the increasing acceptance of breast conservation therapy for invasive breast
Case Report: Ductal Carcinoma In Situ in the Male Breast
Joshua Chern,Lydia Liao,Raymond Baraldi,Elizabeth Tinney,Karen Hendershott,Pauline Germaine
Case Reports in Radiology , 2012, DOI: 10.1155/2012/532527
Abstract: High-grade ductal carcinoma in situ is incredibly rare in male patients. The prognosis for ductal carcinoma in situ (DCIS) in a male patient is the same as it would be for a female with the same stage disease; therefore, early recognition and diagnosis are of the utmost importance. We present a case of a male with unilateral invasive ductal carcinoma who was diagnosed with DCIS in the contralateral breast. The DCIS presented as microcalcifications on mammography and was found to be biopsy proven grade 3 papillary DCIS. This case also illustrates the importance of family history and risk factors, all of which need to be evaluated in any male presenting with a breast mass or nipple discharge.
Tratamiento conservador del carcinoma ductal in situ de la mama Conservative management of ductal carcinoma in situ of the breast  [cached]
Rodrigo Hepp,M Ramón Baeza B
Revista médica de Chile , 1999,
Abstract: Background: Since the widespread use of mammography, the incidence of ductal carcinoma in situ of the breast has increased. Until few years ago the standard treatment was mastectomy, however from the analysis of conservative treatment trials for invasive carcinoma, it was evident that ductal carcinoma in situ could also be treated conservatively. This was confirmed later by randomized trials. Aim: to analyze the experience of our Institution with conservative treatment of ductal carcinoma in situ of the breast. Patients and methods: A search through the data base of our Institution found 69 patients treated with lumpectomy and radiotherapy between the years 1976 and 1997. Results: Twenty three of 69 patients (33%) were diagnosed because of a palpable mass. Eleven of twelve were diagnosed prior to 1990 and 12 of 57 after 1990. With a median follow-up of 48 months local control and overall survival is 97%. None of the patients underwent mastectomy. Conclusions: Conservative treatment of ductal carcinoma in situ of the breast is a reasonable alternative, mainly if we realize that with increasing frequency-the diagnosis is made through mammography and with non-palpable lesions. The results reported in this study are similar to those reported by other centers.
Case Report: Ductal Carcinoma In Situ in the Male Breast  [PDF]
Joshua Chern,Lydia Liao,Raymond Baraldi,Elizabeth Tinney,Karen Hendershott,Pauline Germaine
Case Reports in Radiology , 2012, DOI: 10.1155/2012/532527
Abstract: High-grade ductal carcinoma in situ is incredibly rare in male patients. The prognosis for ductal carcinoma in situ (DCIS) in a male patient is the same as it would be for a female with the same stage disease; therefore, early recognition and diagnosis are of the utmost importance. We present a case of a male with unilateral invasive ductal carcinoma who was diagnosed with DCIS in the contralateral breast. The DCIS presented as microcalcifications on mammography and was found to be biopsy proven grade 3 papillary DCIS. This case also illustrates the importance of family history and risk factors, all of which need to be evaluated in any male presenting with a breast mass or nipple discharge. 1. Introduction Ductal carcinoma in situ (DCIS) in males is exceedingly rare. Only a limited number of cases have been reported in the literature. If recognized, early detection of DCIS can have a tremendous impact on mortality. 2. Case Report A 61-year-old man with an extensive past medical history including hypertension, obesity, noninsulin dependent diabetes mellitus, nonalcoholic steatohepatitis which progressed to cirrhosis, sarcoidosis, and hypothyroidism presented to his family physician with a palpable mass in the right breast. There was no nipple discharge or retraction, however, on physical examination there was bilateral symmetric gynecomastia as well as inflammatory changes of the skin of the right breast. This gentleman has an extensive family history of cancer. His sister died at age 58 of metastatic breast cancer and his father succumbed to complications from melanoma. Additionally, he has a niece who was recently diagnosed with breast cancer. This patient was referred for bilateral diagnostic mammograms and targeted high-resolution ultrasound of the right breast mass (Figures 1, 2, and 3). The mammogram showed a suspicious retroareolar mass in the right breast and two foci of pleomorphic microcalcifications within the left breast. The patient returned 3 days later for a stereotactic biopsy of the microcalcifications in the left breast and an ultrasound guided biopsy of the right breast mass. The pathology revealed grade 2-3 invasive ductal carcinoma of the right breast and ductal carcinoma in situ of the left breast. Figure 1: Right craniocaudal image demonstrates a highly suspicious retroareolar mass which correlates to the palpable abnormality. Figure 2: Focused ultrasound of the right breast in the retroareolar region better demonstrates the biopsy-proven invasive breast cancer. Figure 3: Left magnified craniocaudal image shows branching
Ductal Carcinoma In Situ of the Breast: A Surgical Perspective  [PDF]
Mohammed Badruddoja
International Journal of Surgical Oncology , 2012, DOI: 10.1155/2012/761364
Abstract: Ductal carcinoma in situ (DCIS) of the breast is a heterogeneous neoplasm with invasive potential. Risk factors include age, family history, hormone replacement therapy, genetic mutation, and patient lifestyle. The incidence of DCIS has increased due to more widespread use of screening and diagnostic mammography; almost 80% of cases are diagnosed with imaging with final diagnosis established by biopsy and histological examination. There are various classification systems used for DCIS, the most recent of which is based on the presence of intraepithelial neoplasia of the ductal epithelium (DIN). A number of molecular assays are now available that can identify high-risk patients as well as help establish the prognosis of patients with diagnosed DCIS. Current surgical treatment options include total mastectomy, simple lumpectomy in very low-risk patients, and lumpectomy with radiation. Adjuvant therapy is tailored based on the molecular profile of the neoplasm and can include aromatase inhibitors, anti-estrogen, anti-progesterone (or a combination of antiestrogen and antiprogesterone), and HER2 neu suppression therapy. Chemopreventive therapies are under investigation for DCIS, as are various molecular-targeted drugs. It is anticipated that new biologic agents, when combined with hormonal agents such as SERMs and aromatase inhibitors, may one day prevent all forms of breast cancer. 1. Introduction Ductal carcinoma in situ (DCIS) of the breast is a noninvasive carcinoma with a wide spectrum of disease, ranging from low-grade to high-grade malignancy with foci of invasive malignancy. Histologically, DCIS is characterized by a proliferation of malignant cells in the ductal epithelium that are confined to the basement membrane and are not invading the normal breast parenchyma. 2. Epidemiology Prior to advent of mammography, the diagnosis of DCIS was established only after excision of palpable lumps and histological examination of the tissue. Egan et al. [1], a radiologist based at the MD Anderson Cancer Center in Houston, Texas, is credited as the inventor of mammography in the late 1960s. By 1975, the widespread use of this imaging technique not only resulted in early detection of lesions in the breast but also led to a 60–70% reduction in morbidity and mortality from malignant diseases of breast [2]. The adoption of screening and diagnostic mammography resulted in an increase in the incidence of DCIS worldwide, with 80% of DCIS diagnosed by mammography. Currently, DCIS accounts for 20–25% of all newly diagnosed cases of breast cancer [3] and 17–34% of
Identification of biomarkers in ductal carcinoma in situ of the breast with microinvasion
Yasuhiro Okumura, Yutaka Yamamoto, Zhenhuan Zhang, Tatsuya Toyama, Teru Kawasoe, Mutsuko Ibusuki, Yumi Honda, Ken-ichi Iyama, Hiroko Yamashita, Hirotaka Iwase
BMC Cancer , 2008, DOI: 10.1186/1471-2407-8-287
Abstract: In this study, using resected breast cancer tissues, we compared pure DCIS (52 cases) and DCIS-Mi (28 cases) with regard to pathological findings of intraductal lesions, biological factors, apoptosis-related protein expression, and proliferative capacity through the use of immunohistochemistry and the TdT-mediated dUTP-biotin nick end labeling (TUNEL) method.There were no differences in biological factors between DCIS and DCIS-Mi, with respect to levels of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor type 2. The frequency of necrosis and positive expression ratio of survivin and Bax were significantly higher in DCIS-Mi than in DCIS. In addition, apoptotic index, Ki-67 index, and positive Bcl-2 immunolabeling tended to be higher in DCIS-Mi than in DCIS. Multivariate analysis revealed that the presence of necrosis and positive survivin expression were independent factors associated with invasion.Compared with DCIS, DCIS-Mi is characterized by a slightly elevated cell proliferation capacity and enhanced apoptosis within the intraductal lesion, both of which are thought to promote the formation of cell necrotic foci. Furthermore, the differential expression of survivin may serve in deciding the response to therapy and may have some prognostic significance.Ductal carcinoma in situ (DCIS) is thought to be a precursor of invasive ductal carcinoma (IDC) and is defined as a lesion in which cancer cells do not grow beyond the basal membrane of the mammary duct [1]. Since the introduction of mammography in breast cancer screening, increasing numbers of DCIS are now being identified [2]. About 10 years ago, DCIS accounted for only 1–5% of all newly diagnosed cases of breast cancer, whereas the frequency has increased recently to 15–20% [3,4]. According to the criteria of the American Joint Committee on Cancer (AJCC), IDC with a microscopic focus of invasion less than or equal to 0.1 cm in the longest dimension, is defined as T1mic [5]. In
Ductal carcinoma in situ of breast and current management
Ahmet Nuray Turhan
Medical Journal of Bakirk?y , 2009,
Abstract: Ductal carcinoma in situ (DCIS) is one of the most debatable entities among breast lesions. It is difficult to standardise the management due to improvemenents in imaging studies, better definition of pathological subtypes, wide spectrum of treatment modalities. Although it seems to be a precursor lesion for invasive breast ca, in patients with merely biopsy performed or untreated after ineffectively resection, invasive breast cancer develops in 40%. Moreover, in 10-25% of patients with DCIS, invasive breast cancer is also defined. Mamograpy is stil the choice of diagnosis, although magnetic resonance imaging (MRI) has been widely used. Core biopsy and radioisotope/dye techniques for tumor identification is also gaining acceptance. Mastectomy and breast conserving surgery (BCS) are widely used in treatment. Radiotherapy in treatment is still one of the most debatable subjects among authors although the benefits are proven. Due to multimodality of treatment options current management of diagnosis and treatment of DCIS is reviewed with the light of the literature.
Tratamiento conservador del carcinoma ductal in situ de la mama
Hepp,Rodrigo; Baeza B,M Ramón;
Revista médica de Chile , 1999, DOI: 10.4067/S0034-98871999001100008
Abstract: background: since the widespread use of mammography, the incidence of ductal carcinoma in situ of the breast has increased. until few years ago the standard treatment was mastectomy, however from the analysis of conservative treatment trials for invasive carcinoma, it was evident that ductal carcinoma in situ could also be treated conservatively. this was confirmed later by randomized trials. aim: to analyze the experience of our institution with conservative treatment of ductal carcinoma in situ of the breast. patients and methods: a search through the data base of our institution found 69 patients treated with lumpectomy and radiotherapy between the years 1976 and 1997. results: twenty three of 69 patients (33%) were diagnosed because of a palpable mass. eleven of twelve were diagnosed prior to 1990 and 12 of 57 after 1990. with a median follow-up of 48 months local control and overall survival is 97%. none of the patients underwent mastectomy. conclusions: conservative treatment of ductal carcinoma in situ of the breast is a reasonable alternative, mainly if we realize that with increasing frequency-the diagnosis is made through mammography and with non-palpable lesions. the results reported in this study are similar to those reported by other centers.
Classification of ductal carcinoma in situ by gene expression profiling
Juliane Hannemann, Arno Velds, Johannes BG Halfwerk, Bas Kreike, Johannes L Peterse, Marc J van de Vijver
Breast Cancer Research , 2006, DOI: 10.1186/bcr1613
Abstract: Gene expression profiling using microarray analysis has been performed on 40 in situ and 40 invasive breast cancer cases.DCIS cases were classified as well- (n = 6), intermediately (n = 18), and poorly (n = 14) differentiated type. Of the 40 invasive breast cancer samples, five samples were grade I, 11 samples were grade II, and 24 samples were grade III. Using two-dimensional hierarchical clustering, the basal-like type, ERB-B2 type, and the luminal-type tumours originally described for invasive breast cancer could also be identified in DCIS.Using supervised classification, we identified a gene expression classifier of 35 genes, which differed between DCIS and invasive breast cancer; a classifier of 43 genes could be identified separating between well- and poorly differentiated DCIS samples.Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of non-invasive breast tumours commonly detected in women undergoing screening mammography. DCIS is characterised by malignant epithelial cells accumulating in the ducts of the breast without invading through the basement membrane into the surrounding tissue. DCIS accounts for approximately 3% of symptomatic breast malignancies and for approximately 20% of breast malignancies in patients from population-based screening programs [1].Different histological types of DCIS can be recognised, and a variety of classification systems have been developed [2]. Due to subjective interpretation of the morphology of the lesions, even experienced pathologists differ in their classification of DCIS [3]. Therefore, histological classification of DCIS may not be sufficient, and additional classification approaches could assist pathological classification.It is assumed that most cases of DCIS will progress to invasive breast cancer. Because this progression may take many years and may not occur within the lifetime of a patient, elucidating the mechanisms of progression from in situ lesions to invasive disease and devel
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